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        <title>SIPRUS</title>	
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            <div id="Header3"><br/>SIPRO</div>
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            <div id="Header1">Cadastro de novo paciente</div>
            
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                                <legend>Dados Cadastrais:</legend>
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                                    <tr><td style="text-align:right;"><label for="nome">Nome: </label></td><td style="text-align:left;"><input type = "text" name="nome"></td></tr>
                                    <tr><td style="text-align:right;"><label for="prontuario">Prontuario: </label></td><td style="text-align:left;"><input type = "text" name="prontuario"></td></tr>
                                    <tr><td style="text-align:right;"><label for="diagnostico">Diagnósticos: </label></td><td style="text-align:left;"><textarea rows="10" ></textarea></td></tr>
                                    <tr><td style="text-align:right;"><label for="telefone">Telefone: </label></td><td style="text-align:left;"><input type = "text" name="telefone"></td></tr>
                                    <tr><td style="text-align:right;"><label for="sexo">Sexo: </label></td><td style="text-align:left;"><input type="radio" name="sexo" value="male" /> Masculino<input type="radio" name="sexo" value="female" /> Feminino</td></tr>
                                    <tr><td style="text-align:right;"><label for="procedencia">Procedência: </label></td><td style="text-align:left;"><input type = "text" name="procedencia"></td></tr>
                                    <tr><td style="text-align:right;"><label for="endereco">Endereço: </label></td><td style="text-align:left;"><input type = "text" name="endereco"></td></tr>
                                    <tr><td style="text-align:right;"><label for="historicoFamiliar">Histórico Familiar: </label></td><td style="text-align:left;"><input type="radio" name="historico" value="sim" /> Sim<input type="radio" name="historico" value="nao" /> Não</td></tr>
                                    <tr><td style="text-align:right;">Nascimento:</td><td width="70%" style="text-align:left;"><input name="dia" type="text" maxlength="2" size="2" ><input name="mes" type="text" maxlength="2" size="2" ><input name="ano" type="text" maxlength="4" size="4" >&nbsp;(dd/mm/aaaa)</td></tr>
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                                                <tr><th>Histórico de Consultas</th></tr>
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                                       <tr><td style="text-align:right;"><input type = "submit" value="Cadastrar" /></td><td style="text-align:left;"><input type = "button" value="Voltar" onclick="goBack()"/></td></tr>
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                <b>DAMGeR</b>
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                Sistema de Prontuário
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